A blog about home birth, pregnancy, childbirth, motherhood and all that good stuff.
(blog formerly named What Ifs and Fears are Welcome)

Monday, January 27, 2014

What Drew Me To Home Birth and What Turned Me Away, Part 4

I feel so conflicted with how to wrap this up… I have so much to say, so much that was going on, so much that I was thinking about… hopefully I can get it out in a way that makes sense outside of my head...

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So here I was pregnant with baby #2… and go figure, options were wide open for a home birth, insurance is all set to cover it… and now I was actually leaning toward hospital birth. But I didn’t know. I still wanted a home birth – and partially for my pride at this point.

But the questions and concerns…. Oh so many…

I talked to my two good friends (doula friend and childbirth ed friend) about everything I was going through… I felt so conflicted… and now, to add more confusion for me, a recent birth of a dear family friend had me even more confused and conflicted. At dinner with them one evening, I told them as much as I could about what I was thinking and concerned about and what I had recently learned about that birth: "our family friends just had a baby with a diaphragmatic hernia, perfect low risk pregnancy, she would have been considered a perfect home birth candidate, this was her third vaginal birth with no previous issues in other pregnancies/children. The hernia developed after the 20 week scan so they had no clue their baby would be born with this huge issue. The baby couldn't breathe when born… she couldn’t get enough air… and oxygen wasn’t enough, she needed a ventilator to breathe/stay alive until surgery.... what if that baby were born at home?" I looked at them desperately wanting an answer as I was crying to them… and doula friend said nothing and childbirth ed friend hopelessly said “I don’t know…”

I knew the answer. The chance of that baby surviving had she not been born at a hospital was slim to none.

(On a side note, I was recently reading the Birth Center study that came out in 2013 and one of the babies that died had this exact issue: diaphragmatic hernia. Very similar circumstance as our family friend. It developed after the 20 week scan so they were unaware this would be an issue at birth. The baby in the Birth Center study did not survive. I couldn’t believe it when I read it.)

I went into my search for information on home birth and its safety coming from the perspective of someone who was already sold on home birth. I wanted to believe. I wanted everything to point toward home birth. Sometimes when your searching for the answers to something, the results you find can be tainted by your own personal desires... what I mean is, if you want to believe in something badly enough, sometimes you can find a reason to believe because your desire is so strong. I thought my search would bring me to the conclusion - an even more well-informed, well-rounded conclusion - that home birth is safe. As I felt before. But that's not where I ended up.

By now, I felt so... turned off by the home birth system as a whole in our country. It all felt like it was based off of misleading information, protection of the reputation of midwifery at nearly all costs, a stunning lack of accountability, and stifling those who brought up their concerns.

I had read too many stories of negligent midwives, home birth losses that were very likely preventable... and I realized I had no way of knowing who I'd be hiring as a midwife. It made me sick to my stomach over it... I loved and felt I could trust our midwives implicitly and I believed in their skills... but I have yet to hear a home birth loss story where the mother didn't feel the same about her midwives... midwives who later betrayed the trust by taking chances or with flat out negligence. I felt more confident going the CNM route because I know they have their nursing board to hold them accountable. But even then, there's no guarantee... even if they are completely ethical and do everything right, what if I am that small statistic that faces an issue that can only be resolved in a hospital..... my house isn't that close to a hospital. It would take quite a bit of time, especially if it were during rush hour. It just..... it felt like a gamble.

And I realize in the hospital, it is also a gamble. You never know the doctor or nurse you will get. You never know what kind of day they are having. You never know what their philosophy is. You never know how outdated their standards of care may be. To a certain extent, you have to put blind faith in a care giver. But at least in a hospital, you have accountability. Accountability is crucial. And I've looked at the numbers... vital statistics, hospital stats, studies, etc... our hospitals in the USA do a very good job of making sure our babies are born alive and safe and healthy.

I believe there is a certain element of childbirth that is mental. I, personally, wanted to take this into consideration as well. It's mental in that.... it's the woman feeling comfortable and safe and letting her body do what it needs to do. In that mode, that safe space, a woman's body functions at 100%, the hormones, the labor, everything... it just functions better. I think that there is a lot of propaganda out there in the home birth world that leads women (or maybe just me) to believe that being at home, in that familiar place, that that is where birth needs to happen to allow the woman to feel that way.

My own hospital experience was quite nice with our first. And I understand that it may not be the norm. I have experienced other hospital settings as a doula where things weren't as nice and where there was some fight needed by a mother/couple to get evidence based care. And like I said in my first post, I read many, many stories of hospital experiences that were not as nice at all.

The childbirth ed midwife said to me once, during my first pregnancy: “you have to decide: where do you place your risk?” So that’s what I had to do. I had to decide where I would place my risk. I had to think about my options…

What are the true, unbiased risks?

What risks could happen at home that could only be remedied in a hospital?

What risks could happen at a hospital that could only be avoided by being at home?

I took everything into account that I could... infections that can be caught at home and/or in water (water birth), infections that can be caught in a hospital, childbirth risks that can happen to anyone/anywhere...

I had my answer.

In a hospital is where I needed to have our baby.

I felt I had the best of both worlds in the hospital, with my birth team: my husband and my doula. I can hope for another fantastic nurse, I can hope for another lovely doctor... but there is no guarantee. But there is a guarantee that my birth team that I trust will help me ask questions, help me ask for options, help protect my space, help me feel uninhibited and unembarrassed and safe and able to surrender to the process, help my experience to be as close to my desired experience as possible. The doctor and nurse(s) may add to that team or may make it a challenge for that team but regardless, they will be there to keep us safe. They will have the interventions and equipment if needed or wanted readily available.

This is what worked for us. I felt that while home birth can sometimes be a safe option (and I wrote a blog post where I put together a list of things, based on my fairly extensive research, of what makes for a safe home birth option). But it wasn't going to be the right fit for us.

By Spring/Summer (ish) of 2012, I was 100% confident in my choice to have another hospital birth. But not only that, I felt compelled to share my journey, through my blog, shared the things I learned along the way, to process it all, and to maybe even help others that may be in the same boat I found myself in.

I knew publishing my first blog post would change certain things for me in my life. Specifically, it would change certain relationships. And it has. As you can imagine, it ended certain friendships. Our doula backed out of being with us for our birth. I was told by a birth world friend that my blog was "too negative, too extreme, I was advocating that women live life in fear." But that's not what it was about for me at all. I had so many "what ifs" running through my head when I was in the process of making the decision of where to have our 2nd baby... so much fear that I'd make the wrong choice (and other fears, too)... I had to hash it out. I wanted to make an informed decision. I wanted to feel confident in my choice. This is how my blog earned it's name... it's not about living life in fear or in a constant state of being bogged down by "what ifs." It was about allowing those "what ifs and fears" to guide me to gathering more information so I could feel confident in my choice; feel empowered and well-informed.

My blog started me down the path of advocating for change.

I believe education and standards and insurance and transparency are so incredibly important for home birth midwifery. My advocacy comes from a place of not trying to limit options -- it's from a place of believing that women deserve the best options.

**If you'd like to read more about home birth in our country, birth centers, studies and statistics, and more, click here.

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You are reading Part 4 of "What Drew Me To Home Birth And What Turned Me Away." Click to view:

42 comments:

I have given birth 5 times. I did not want interventions, epidurals, rupture of membranes etc... I had 3 in hospital vaginal births where my wishes were respected up until my plan butted up against what was in my baby's and my life's best interest. My doctors knew when to coax nature back into the safety zone. I also had 2 c/sections, but they were not sequential. DD2 and DD5 were my c/secs. Again I had wonderful respectful care and I was nursing while being sewn/stapled back up.

That sucks your doula dumped you because of philosophical differences. I was so scared my OB would find out I believe in the power of reiki because he might refuse ... hahaha! Oh, wait. Doctors do not select patients according to ideological conformity.

It's one thing to disagree and sever friendships. But to abandon a client who is in her professional care? Wow. That says a lot.

Yes, that was rough. But it was OK. I asked someone else and it all worked out.

I added that part about the friendships not b/c I wanted to throw them anyone under the bus. If I look at things from their perspective, I can see how my blog could feel like a personal attack to them. But rather, I added that part because I just wanted to share how personal and how real this all was and there were consequences from speaking out and voicing my concerns. It would have been easier to just stay quiet. But I couldn't..... I felt I owed it to anyone who might be in a similar place that I was in. Ya know?

I understand this completely. Most of my friends homebirth and when I started understanding and voicing the risks more... it was scary. When I do talk about it, I'm being bad and scaring them. When I don't, I feel so frustrated. I have let most of them know my worries via email or blog post, now I leave the room whenever they start talking about it. I don't live near my family, so my friends are my support network and I need them. It's a tricky, tricky thing. Very personal.

Hey hon it's Kayla. This has been a wonderful piece and in certain ways it mirrors my journey. I wanted to say before I started my story that simply telling the truth is not a personal attack (although some truths can be....like outing someone to hurt them for example. But it's obvious to me that there was no personal attack involved here) .

I was pretty big into the woo. A big old intactivist....that was my big thing but I was big into cloth diapering and baby wearing and home birthing and Co sleeping. I just didn't understand how anyone could not hold the positions I did. For me it was a bit of intactivist rhetoric that made me go wtf? So I went and reexamined everything. First with intactivism then everything. Suffice it to say that my views are now very different. The one area I am proud to say I didn't get sucked into the stupid about was vaccines. And I'm glad.

But changing my views left a lot of people feeling very alienated. Because it's hard to hear you advocate for a dangerous practice that can kill babies. But it is also important to get the info out there because there's tons of woo online and very little going against it.

I'm curious how your views changed about intactivism. That is something that I feel like there's no going back from, personally... so I'm very curious what new information you got that changed your position.

It's a look oolong story. I will write it down and copy pasta but the 2 most glaring issues are that the science doesn't say what intactivists say it does (sensitivity, hiv reduction etc) and when they can't find the science to back up what they say they make it up. Bollinger is on almost all of the studies intactivists love to use. He's a joke. The second issue is how foul intactivists can get, calling names, wishing rape or death, calling people whose posts they disagree with at work, and being insanely nasty to a woman whose son just died of hplhs.

Just wanted to say that you *can* know which doctor or midwife will attend you in the hospital, if you go with a small practice who is upfront about their call rotation. I am one of 3 hospital-based CNMs in a private practice. Our patients meet all of us throughout their prenatal care and know that we all share the same philosophy. One of the three of us will definitely be at their labor or birth...it's a big reason why women come to see us.

I go to a smaller hospital that has 4 obs. I've seen each of them, but I know which day and night my favorite is on. And my second favorite. :) I have to have c-sections though and so get to schedule with my fav. A perk, I guess! It is nice to know all their faces though!

Thank you for sharing your story. I was once much more into Natural Childbirth, took a Bradley class, etc. I never planned a homebirth but have friends who did. Then I had a c/s with my first, and my second (VBAC baby) required a 17-day stay in the NICU for sepsis and meconium aspiration, all complications of the labor itself. He would have been fine had I had a repeat c/s. Anyway, he is fine now, too, due to the work of many doctors and nurses who saved his life. I have done a complete 180 on NCB and all that. Oh, did I mention my post partum hemorrage? I love my OB!

Side note: my OB is a solo practitioner, so I have gotten to know him very well. The nurses are still a crapshoot, but I have full confidence in my doctor.

Thank you for sharing all of this - reading your story has opened my eyes a little and has gotten me questioning. I've been fairly pro-homebirth since my awful experience with a hospital birth (although I can't blame the hospital without accepting my own share of the blame for not educating myself beforehand and allowing myself to be pushed around). I, too, watched The Business of Being Born one day and felt like a light was shining through the darkness. I regretted not having had a birth plan the first time around and promised myself that I would do everything in my power to make a home birth happen the next time around. Well, that next time hasn't happened yet and although I am certainly still interested in the option of a home birth, people like you remind me to think critically and do the research for myself before making a decision. It's easy to be swayed by manipulated numbers and unrealistic expectations and the entire Pro or Anti home birth war is EXHAUSTING! I still feel confused and need to learn more but thank you for being so open and sharing your journey! It has been really helpful!

CB ~ I do think you generally provided your thoughts/opinions in a way that is not trying to cause an uproar but that is definitely attempting to sway others to your side of things... bringing us through all of your experiences and that is noble. I, too, have done tons of research on this subject... less recently (though I do try to keep up on some of the latest info when it passes my way), admittedly, but my experiences (personal, professional, and research-wise) have brought me to the conclusion that a woman/baby couplet who are healthy and a skilled care provider (preferrably a CNM) are at least as safe at home as they are in the hospital. I have had one hospital and one homebirth and I, too, have witnessed both types but not from the perspective of a doula but as an RN. You believe there is accountability at hospitals but there is not always accountability not for the nurses and even less for the doctors. Is this true everywhere? No. But it happens more often than most people know. And it doesn't just happen in the OB floor, either. If a baby dies in the hospital, yes, most likely there is accountability but for the unwarranted interventions because a MD wants to make his tee time or to be home for dinner or whatever a blind eye is often turned. When parents express their desire for certain things to be avoided they are sometimes openly scoffed at and often scoffed at behind their backs simply because the MD/RN's don't agree or were trained differently... I don't say this because I think the home birth community is perfect. I DO NOT! I think we need reform in our entire health care system (and I am not referencing any recent legislation) but especially where it concerns maternal/infant care. It starts from within though... we as women must demand evidenced-based care. Blindly trusting a doctor or midwife is NO good. Thanks for opening the forum and your own personal struggles with it. Blessings. Let's keep the conversation going.

Well accountability when there is a death or serious injury is when it is most important.

I shared my story not in an attempt to sway others - though I did know that it might - but I shared it so people could really understand where I am coming from. Most people who speak out about the issues of home birth midwifery here are labeled as being too extreme or being anti-home birth. That is not me. I did a *lot* of research about home birth - probably more than many home birth moms. And I continue to do more.

What are your thoughts on having a good birth team for a mother to help her get evidence based care in the hospital, especially when there are doctors/nurses who may be pushing a mother into interventions for sake of trying to rush a mother in labor b/c "a MD wants to make his tee time"?

I respect the path you have taken, and as a doula and a mom who has had 4 homebirths...I can tell you that a lot of what you found is definitely true. I often get frustrated with the rhetoric in the natural birth community, and the circling of wagons when any midwife is charged with endangering women.

However, a big shortcoming we have in the data to date comparing home and hospital birth is that we don't have any studies tracking women from when they start prenatal care forward. Are homebirth midwives helping women--through prenatal care--to avoid having complications that would lead to higher risk births? Looking to the next birth, there is data that suggests that having a cesarean increases the rate of unexplained still birth in future pregnancies--is the reduction in cesarean births in homebirths reducing the overall rate of still birth?

Having had two "good" hospital births with mostly supportive care providers, I can still tell you that there really is no comparing home and hospital birth for emotional atmosphere. But yes, there is that issue of "what if?" and I certainly respect women who find that they are better served--emotionally--in the hospital.

I think we really need to work on the skill of home birth midwives, and the collaboration with hospital providers. I think this would reduce a lot of the excess perinatal mortality that we see now in homebirth.

I think there is so much to learn from home birth midwifery. I learned so much in my childbirth education class about diet and nutrition during pregnancy (taught by a home birth midwife). My hope is not to make home birth obsolete -- but to make it better. In my opinion, it starts with midwives earning hospital privileges and carrying malpractice insurance -- then care providers who collaborate with home birth midwives don't carry all the burden in case of a bad outcome. It would also ease transfers - make them more seamless. And it benefits women greatly, emotionally, who have to transfer to be able to have their midwife continue care in the hospital.

You have had a wonderful journey and have come to a plateau based on your experience. It is great you shared it and released it. I wish to only tell the readers: This is a blog, This is someones opinion. This is someone trying to communicate her feelings about a subject she has mulled over and exhausted for what sounds like years. What makes it beautiful is that it is hers, however that does not mean it must be yours. We are all on a very specific journey. I feel it is terribly upsetting that we should attempt to throw blinders in each others eyes as we go on our way.

Dani, May I also just say, you mentioned some disgust towards your facebook post about induction. Your attitude toward it now causes you to cringe. However, who is to say this revelation won't also make you uncomfortable someday? Praise you for reaching this place. Praise you more that you have such a way still to go.

Wow! What a passive aggressive comment. Sounds like you may have a bit to go in your journey as well.

So I'm trying to throw blinders in people's eyes by sharing my story? That's why I wrote it out was to blind people?

Yes, I cringe at that Facebook comment b/c I had no idea how lacking in evidence it is to say that "baby will come when good and ready and not a moment before!" My views on induction once passing the due date were based on opinion and anecdotes. Now my opinion on induction is based on evidence. You should read my induction blog post!

And also, I disagree completely with your *insult* saying that I've come to a "plateau." I have learned so many valuable lessons through this process that I implement daily. I am passionate about my advocacy. It is a part of my DAILY life!!

Finally, your comment was about YOU. You clearly felt threatened by what I wrote and you are trying to discredit what I wrote and discredit my own personal journey to make you feel better and for the sake for your cause (since you are a home birther as you mentioned in another comment on my blog).

Thanks for posting this series. I really identify. I was also quite into the natural birth idea but never seriously contemplated a homebirth because I planned to birth in a hospital birthing center with CNMs, which I thought would be the best of both worlds. I ended up with a much more interventive birth than I had planned (pitocin, epidural, and every kind of monitoring) and struggled for over a year afterwards to stop having negative feelings about it - even though it was overseen by CNMs in the hospital. I, too, hesitantly and reluctantly visited Dr Amy's site and while I still find her to be mean and abrasive, I believe that when it comes to the risk of homebirth and debunking certain claims of NCB philosophy, she is right. I do still believe that birth has a mental/psychological component, but that this is hard to quantify. I feel like a lot of the anxiety and negative feelings about hospital birth and interventions are manufactured or conditioned by blogs, books, childbirth classes etc. For instance, I think that my mixed feelings and faint regrets and my "well maybe I'll get my natural birth next time" feelings about my daughter's birth were completely unnecessary and that I had excellent care. I feel lucky that my feelings were only "mixed" and "faintly" regretful rather than angry or traumatized or militantly anti-hospital, and actually I credit my doulas for some of that.

My doulas, two volunteers (who I met just that day) supported me through the unpredictable roller coaster of birth and totally supported my decision to get an epidural after 16 hours of labor and 36 hours awake. On reflecting on it afterwards, I came to understand the doula's role as helping the mother through the journey of birth so that she feels safe and is less likely to be traumatized. In this sense, she totally succeeded and it had nothing to do with her advocating for me or stepping on doctors' toes or trying to block or talk me out of interventions. A doula can be helpful for any kind of birth - not only those that live up to a particular ideal. I feel like you are among those who understands this.

"I do still believe that birth has a mental/psychological component, but that this is hard to quantify."

Yes, me too.

I agree, sometimes I think the NUCB movement sets women up to feel like failures and can be too rigid. In a board I used to be a part of, someone wrote a post once condemning those who had induced/augmented labors and still calling them "NUCB." Ridiculous. Is it a competition?

That's awesome you had volunteer doulas! I dream some day of starting up a program for my hospital (or multiple area hospitals) for volunteer doulas. I think having someone there for support, without pushing an agenda, just there to check in with the mom and make sure she feels confident in her choices, it can make such a huge difference in how a woman feels afterward. No one has control over birth but there are ways to help women feel more in control and less scared of what's going on, especially in times where complications come up. Some nurses and doctors are amazing with this but not all are, not every day.

This is very interesting and I really appreciate your candor. I'm in the process of getting my RN to eventually become a CNM and have had a lot of questions nagging at me lately. My 3rd child was born at home with a CNM and thankfully, everything was perfect. A lot of the studies have left me with questions and I have a lot of searching to do. No offense, but I learned a long time ago that I have to find the answers on my own and not just take a bloggers word for it. The biggest concern I've had as of late is over the whole Jan Tritter/Christy Collins baby and the comments from lay midwives and cpm's that have followed. It just doesn't add up. As an aside, you look to be a redhead, are you? Fellow redhead here and I hemorrhaged at my second, CNM attended Birth Center Birth. It was well controlled and I was fine, but it led me to seek out answers. I found an interesting article with statistics showing that redheads, fair skinned women and women from European descent are more likely to have a hemorrhage but with redheads taking the lead. They are unsure of why exactly, but it's an interesting correlation. Anyways, thank you.

"No offense, but I learned a long time ago that I have to find the answers on my own and not just take a bloggers word for it"

I completely agree. I think women should carefully consider the risks of childbirth, risks of birthing in either location, take studies into consideration (studies regarding home birth in the USA), research different types of midwives, etc etc. I like reading the studies for myself, not just taking someone's word for it. It's why I reference/link everything on my blog, so people can read for themselves.

"The biggest concern I've had as of late is over the whole Jan Tritter/Christy Collins baby and the comments from lay midwives and cpm's that have followed."

Yes, it was horrible. All of it. The comments were disgusting.

" I found an interesting article with statistics showing that redheads, fair skinned women and women from European descent are more likely to have a hemorrhage but with redheads taking the lead"

Every nurse I ran into in the hospital for both births made comments about redheads being big bleeders! So odd. I'd love to read the article!

Dani,Thank you for taking the time to share your story and insight. I am a CNM. I have only worked in hospital settings. I tell the families I work with that birth is just the very beginning of the long process of being a parent. And, as we all know, parenting is complicated! At times it is fabulous and perfect, at others it is difficult and challenging. The very act of becoming pregnant is a leap of faith. We give up full control of life at that point. But, in letting go we gain so much more, the opportunity to nurture and parent a new life. This is why I encourage women to have an open mind. Also, any choice they end up making about interventions should come from a place of kindness to herself. For example, if you elect an epidural, view it as a gesture of care for yourself, not a failure! Being extreme or exclusive can make one's heart constricted. An open heart makes the journey much nicer, don't you think? Be well, Dani, and good luck with your future endeavors. The fact that you are a thinker, that you look for the evidence, that you ask questions, that you ask for help, will serve you very well.

I just stumbled upon your blog and I just want to tell you how much I appreciated your honest thoughts. I am so impressed with your genuine search for truth and your willingness to fairly assess your options. It's so important that we, as mothers, look for legitimate sources and reason out our decision without letting our emotions or biases take control.

I find myself in a fairly similar situation. I live in Brooklyn and there is a strong home birth movement here. Many of my very closest friends are firm advocates (thankfully, whether or not I agree with them on home birth doesn't affect our relationship). I still honestly haven't decided if it's right for me or not. I just want to hear more stories like yours - those that offer an honest approach, who understand both sides and genuinely care about people in both camps. Like you mentioned in your posts - sources that censor so carefully aren't trustworthy in my opinion. It's so hard to find online sources that admit that their opinions may have flaws - no matter what their opinions are. I've always felt that if some method (in this case home birth or hospital birth) is truly the best, it will be able to face opposing opinions and not simply crush or erase them.

So thank you for all the time and energy I'm sure you put into this. I don't normally comment online, but I just really felt you deserved some thanks.

As an RN that works in the NICU and post partum, it makes me sad people think having a baby in a hospital is a horrible option. Our goal 99% of the time is to have a healthy mom and BABY. (There will always be thar select few who have their own agenda, but this also happens in home birth.) Many people come in with birth plans and their requests are part of our everyday routine. I don't know where they get the idea we poke everyone with needles and give tons of medications and rip a healthy baby away from their mother.On the NICU side I have seen things go bad, and go bad fast! I always tell new employees when setting up for a delivery, "plan for the worst but pray for the best." There are so many life threatening things that can happen when a baby is born. Thankfully the large majority of babes are 100% fine, but think about that very slim chance- a hospital a equipped to deal with that slim chance is safest.

"I don't know where they get the idea we poke everyone with needles and give tons of medications and rip a healthy baby away from their mother."

They get it from homebirth activists. That is what mothers in the care of the natural birth extremists are led to believe - and it's not TOTALLY off-base depending on which hospital you look at. I think the face of hospital birth is changing for the better, however, and thank you for all you do to make it a positive experience. :) The nurses I had in my 3 births were angels and you're all the unsung heroes of the medical world.

Dani I seriously appreciate your posts!! There are SOOO many options and opinions flying around - everyone has them! I truly value your insight and your research. As a brand new mom-to-be (7 weeks!) people keep telling me to watch The Business of Being Born and to really "do my research" - and again, so many options and opinions. Safety, of course, will be our #1 concern and I never imagined not being in a hospital setting with the comfort of knowing there are experts all around "just in case." I have also heard the horror of pitocin and an epidural and am still doing my research, but I have found an OB here in San Diego that is on board with the natural birth and delivers 95% of his patient's babies. He's also from the midwest, which I, of course, love! Anyway, I just want to let you know that I seriously read everything word for word and appreciate putting yourself out there. The truth is more important than anything!!

I just wrote a very long THANK YOU for your honest and heartfelt words, but then accidentally deleted it. Suffice it to say, I am so grateful to you for helping me to sort out my own feelings on this topic. I've spent years lamenting the fact that I could have had beautiful home births with any or all of my six children but didn't. It's easy to wish for something different in hindsight, knowing that everything turned out well. But all in all, my hospital births were positive experiences, and even the things that weren't ideal were valuable learning opportunities for me. After reading your honest, well-researched and informative posts I am at peace with my decisions to have hospital births, with the CNMs and doula who supported me. It really was the best of both worlds. Thank you so much for putting so much time and thought into this, and helping other women on their journey to find what is truly best and safest for them.

Thank you for posting about your journey. I admire that you looked at actual studies, real data, So often when someone says they "did their research," it means they looked at lot of opinions and talked to a bunch of friends.

I wanted a "natural" delivery. No, scratch that.. I wanted a healthy child. Sometimes, we forget why we get in to this whole pregnancy thing. Its NOT all about YOU, its about having the healthiest child you can. Often that does mean less intervention, but sometimes, it means more intervention, more doctors, more medications and NICU care.My first child was born by C-S after prolonged labor, interventions to try to advance labor, etc, but no dice. I had my first healthy child. My second was an un-medicated VBAC. My second healthy child.

Thank you. Your 2nd paragraph is wonderful. I work in a NICU . . we are the land of birth-plans-gone-wrong. The health of the baby is way more important than whatever is written on that paper. I wish, when people wrote up their plans, they wrote them with a column that said "Baby not doing well"------>scrap plan. It is beyond frustrating to be called back to look at a baby and have the family refuse to turn the lights on, or unwrap the baby, etc. We want everything to be perfect for you as well, and we most certainly would prefer your baby stayed with you. I'm all about breastfeeding/bonding . . but if your baby is having trouble breathing or is septic . . . minutes can make a difference. We are not the enemy.

HiYour post brings up a lot of good points about the studies done on home births. You obviously did a lot of research! I have done 1 home birth's with no problems and planning for another in December 2014. I do get worried about something going wrong, but I do have a hospital very close to me. Check out my blog post on my home birth experience http://www.azmomma.com/?p=564

Thank you for writing about your experience. I admire that you did so much research in order to make a decision you were comfortable with. With baby number 3 on the way, your blog has become part of my homework.

Dani, thank you so much for taking the time to write this all out. I am floored by what you discovered in the real numbers.

As someone who was terribly wounded by how deeply I bought into all the same philosophies you outline in this story, and then had my "perfect birth" dreams dashed twice by complications from being overdue, I sympathize greatly with your position. I received wonderful care from my midwives, who were CNMs and rightly had me make hospital transfers both times, and I absolutely do not want to discredit them as they had impeccable judgement and experience. It was my own mindset that turned the experiences (particularly birth #2) into traumatic ones - the fear of the hospital, the bitterness over the perceived "failure" of my body to do what it was supposed to know how to do, the anger that I had done everything "right" and it hadn't mattered, the distrust of the medical staff - all things propagated, directly or indirectly, by the hard-line philosophies of the natural birth movement - turned what really were uncomplicated hospital births, births many women would be happy to trade for their own terrible experiences, into nightmare in my memory of them. While neonatal mortality is clearly the most important factor to consider, my experience shows that, even in cases of healthy baby/healthy mom, the fight between home and hospital birth philosophies can have negative consequences in other aspects of a mom's life.

I was lucid enough once I came out of the postpartum madness to own my choices and realize it was no one's "fault" that things had turned out the way they did. The natural homebirth proselytizers believe strongly in their convictions and I am certain they mean only the best toward mothers, and pregnant moms are incredibly vulnerable and eager to believe in their messages of empowerment. But the hardline stance most of them take on hospital birth is not helpful. It is, in fact, emotionally devastating to women who wind up having to transfer, and probably makes for many cases in which a necessary transfer is refused or delayed because of a mother's fear and distrust of "the system". I wonder how many babies are lost for that reason alone, which can only compound the grief and guilt experienced by the poor parents.

For my third child, who I knew would go all the way to and past 42 weeks like her brothers, I chose an OB (who, ironically, refused to induce me before 41.5 even though I begged!), hospital birth, medicated, 180 degrees away from the births I had planned for the first two - and it was the most peaceful, beautiful, healing experience I could have wished for. Sometimes you just have to roll with what life gives you...and if anything, this is the message I should have taken away from birth advocacy. Their message gets lost in their zeal.

Couldn't agree with you more! Yes, there is definitely an "us" versus "them" feeling in the home birth and natural birth worlds versus the medical/hospital world. There is not enough emphasis on the healthy reliance of the medical world when birth veers from normal to not-so-normal and this absolutely makes a difference in how women are able to process their births in cases such as transfers from home birth and if any interventions coming into play.

Thank you for sharing your story. How wonderfully enlightening! I also felt quite drawn towards home birth and home -based midwifery care, for my own pregnancy and birth (I am due in Feb 2015). But being a scientist by profession I am somewhat subconsciously trained to look at data from both sides of the story. When I looked at some of the data on safety of homebirths, how midwives are trained in the US and also about how home birth increases the risk for babies, I decided against it. The weird part is homebirth advocates only seem to present these happy, glorious births data. In any birth there is a risk of maternal and neonatal mortality. Why don't midwives ever share that? That seems very one-sided and scary, as though they are trying to push something unwanted under the rug. Obstetricians and medical personnel openly share (most of the time) rates of neonatal and material mortality.

Yes, in a hospital there might be too much intervention and I might not have the birth experience I want. But that is something minor, something I can deal with. At least I feel that my baby and I have a greater chance of survival in a hospital if there is an emergency. Having 2 days of crappy labor with interventions, c-sections, epidurals, episiotomies and doctors with terrible bedside manners is a smaller risk than suffering hemorrhage or having to deal with increased risk of death to my baby and me during a home birth. C-section recoveries, episiotomy stitches I can deal with. The experience is less important than my baby's or my safety. I don't want to be wishful in thinking that I am all healthy and will never have any kind emergency. I want to be prepared, and I think being in a hospital with my partner and a supportive doula gives me the best of both worlds.

Good for you for writing these articles, and good for you for making an educated choice. We did also (my husband and I) and were thankful that we ended up in a hospital after I too had bleeding and clotting issues and needed drugs. Yes, my homebirth friends poo pooed me but we were very well cared for. All I can think of is 25 years ago being the 10 year old girl that was very informed and educated about natural birth (I grew up on a farm) and my parents giving birth to my brother who had a serious heart defect, not found until immediately after birth. He was medflighted and had several heart surgeries before coming home at almost 6 months of age. This baby is now grown and is a successful young man- that would never have survived if he had been born at home.

Thank you so much for writing this blog. I am a Labor and Delivery nurse. I know why women want to have home births and understand their need for feeling safe in their own home and feeling like they have control over their labor and delivery process and their infant when at home. I feel it is safer to have a delivery at the hospital where medical interventions and equipment are available if needed. Our unit and physicians are wonderful. As long as everything is ok with the baby, then we pretty much let them do what ever they want. We let them shower, walk, squat while pushing, use the labor ball to sit on. Whatever makes them happy. We want them to be in control of everything concerning the labor and delivery process. I think some soon to be moms do not research enough and are just dead set against a hospital birth. If they only knew that 5 minutes can literally make the difference between a live born infant and a baby that does not make it, then I think that they would choose the hospital. Thank you for sharing your story and congratulations on your beautiful children. We need more people like you than can keep their minds open about these situations. My daughter wants to have a home birth because she hates going to the hospital. I have talked to her about the dangers and will be showing her your blog tomorrow. I want a healthy grandchild. That is all that matters in the end. A healthy baby and a healthy mom.

Thank you for sharing your story. I am surprised at just how similar our birth stories are- but unlike you I had my first birth at a birth center with midwives when I massively hemmorhaged. This is my bloghttp://thehealthshock.com/2014/10/29/lessons-about-health-life-and-motherhood-a-birth-story/I would love to connect sometime if you want (I am pregnant with my second, and choosing a hospital birth this time!) and possibly post some links to your studies on my website :)Thank you again for having the courage to speak out with your story.

I really have enjoyed reading your posts! I am especially grateful for your posts on questions to ask midwives and equipment/training they should have. I tend to be shunned a bit in the hardcore natural birth community bc I am not signing the petition to make CPMs illegal and I warn new moms about hiring illegal midwives. But I truly think the best thing for natural birth is being on the up and up and being accountable and making standards of care better! If all the passionate women I knew could get on that boat--I can only imagine the possibilities for birth in he US!

I agree that the us vs them mentality is an issue. It goes both ways and is hurtful and unnecessary. It's the main reason why I hesitate to label myself because truly my birth decisions are personal and as a doula I enjoyed supporting families who chose very different experiences. The judgement and blaming is just heartbreaking. Home birthers judging parents who choose medical interventions and hospital birthers judging parents who choose to birth at home. Blaming poor hospital birth outcomes on the interventions allowed by parents and even worse blaming perinatal deaths on parents that chose home birth. It is the healthcare professionals who we should be looking to for responsibility in all of these situations. Expecting them to follow ACOG guidelines and working together for better experiences and less interventions (if desired) in hospitals and more seamless transitions from birth center and home births.

As for my personal experience, I had a very long and hard first labor at a CABC accredited birth center. My son was poorly positioned after 9 months of prenatal yoga and eating whole and preparing my mind and body (the doula curse, as we later joked)! BUT it was such a positive experience. My midwives made me feel very confident that though my labor was hard, they were following safe protocol and my baby was doing well. They were in touch with the back up OB as my pushing extended into a 4th hour. I delivered in the oddest position, but it worked and I was so grateful for the knowledge of my midwives and the faith they placed in my body to deliver my baby. I do not say this lightly, but I am positive (as were they and the back up OB) that had I been in a hospital I would have ended up with a c-section. Being pregnant again with number 2, I am even more grateful for my normal birth and going into a 2nd birth uncomplicated. I tell my story just to say that there are legitimate safety reasons to choose home birth and for me avoiding a serious and unnecessary abdominal surgery is one. I guess I am a bit defensive. I recently read Dr. Amy's article that a home birth death is the parent's fault. I dislike her take on things because I think she could do more. She could write to a homebirth audience. She could educate without being condescending. And that goes for hardcore natural birthers as well. We need to talk to each other with open minds instead of at each other with hardened hearts. And ultimately we should support parents!